Auto accidentr NY No-Fault

[cuddles1200]

My husband and I were involved in a car accident 9 months ago. Hit by another driver who was going 50 mph. We were completely stopped in traffic. We both sustained injuries for which we are still receiving treatment. Our new car was totalled. Our own insurance comapny (NY) has treated us in a most despicable manner regarding claims we have submitted under no-fault for outside help and medical care. They have been guilty of so many bad-faith practices it is unbelievable. The necessity for such care has been documented by our treating physicians on numerous occasions. After 8 months of abusive treatment, we filed a complaint with the NYS Insurance Dept. against our insurance company. Most recently, and as a result of filing this complaint, our insurance company was forced to turn over to us copies of IME exams (which, to no surprise, were a complete joke!). These reports, based on IME exams ordered less than 5 months after this accident, are riddled with flagrant inconsistencies, contradictions and outright lies, including claims that all of these so-called "tests" were performed during these exams which were not.In addition, the reports were in such a standardized format that some of the wording was exactly the same for both of us even though we sustained totally different injuries. We, thankfully, had the foresight to document in great detail the events of each of these exams upon returning home from them and have forwarded the IME reports as well as our own ACCURATE description of these exams and a letter outlining these gross discrepancies to the Insurance Dept. These IME reports were used by the insurance company to terminate any and all benefits to us for household help and medical care, totally disregarding any of our own physicians' documentation. This is also the second time that our insurance company issued total denial notices. How much power does the Insurance Dept. have in
resolving this issue? We have maintained extensive documentation of each and every example of bad faith by our insurance company and have been forwarding this information to our state's Insurance Dept. for the past month now. What kind of help, if any, can we expect? Does the Insurance Dept. turn over each and every piece of documentation we send them to our insurance company or should we send copies to our insurance company ourselves? Thank you for helping.

 

[Juan Rodriguez]

I am not familiar with the NY Dept of Ins per say but in most cases they initial complaint is handled by a consumer specialist who tries to evaluate and resolve the problem, if they deem there is one. If they feel there has been some violation of the insurance code they will refer the file to another division which specializes in dealing solely with violations by a specific type of entity or licensee.

Resolutions take the form in your case of the benefits being restored. A referral to another division would mean that an analyst may conduct an investigation and/or inspection of the company and their adjusting practices. They can levey fines and as a last resort revoke licenses.

You can also file a complaint against the doctors with NY's equvilent of the department of proffessional regulation or the AMA.

You may also want to consult a personal injury attorney.